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Flashcards in Liver test 2 Deck (149):
0

What do you have to show when you sweep through the liver?

left, right and caudate lobe

1

What is the largest parenchymal organ in the body?

the liver

2

Where is the liver found?

in the peritoneum

3

The liver is a chemical factory? true or false

true

4

What is the parenchyma?

the texture of the liver tissue

5

Renal cortex is ____ echogenic than the liver

Less

6

Renal sinus is ______compared to the liver and to the renal cortex

echogenic

7

Renal cortex is _______ compared to the liver

hypoechoic

8

What organ is similar to the liver in echotexture?

the spleen

make sure you label!!

9

what is more echogenic than the liver or the spleen?

the Pancreas (gets brighter as you age)

10

What is anterior to the portal confluence and splenic vein?

the pancreas

11

What is the normal size of the liver?

varies

typically 18 cm (anything between 15-18cm)

12

What part of the body does the liver occupy?

right hypochondrium

epigastrium

left hypochondrium

13

What covers the liver?

ribs

14

Where does the stomach lie in comparison to the liver?

stomach lies posterior and lateral to the left lobe

if confusion about a mass or stomach...will have parastalisis if its stomach

15

What lies adjacent to the liver?

duodenum

16

What is posterior to the liver?

rt kidney

ivc

Ao

17

What is the superior border of the liver?

the diaphragm

18

What is the liver suspended by?

the falciform ligament

19

What mostly covers the liver?

peritoneum

20

What is the bare area of the liver?

the area on the posterosuperior (diaphragmatic) surface of the liver

bordered by the coronary ligament but itself devoid of peritoneum

the diaphragm and liver lie in direct contact and adhere

21

What is the space between liver and kidney?

subphrenic space or morison's pouch

22

Where does fluid accumulation or abscess accumlate around the liver?

subphrenic space (aka morison's pouch)

23

If you see fluid in Morison's pouch what do you do?

a four quadrant sweep

24

What is the largest lobe of the liver?

right lobe

25

What is a fossa?

an impression of where something lives

26

What are the fossa's of the liver?

porta hepatis

gallbladder

IVC

27

What is reidel's lobe?

a congenital variant

an anterior projection on the right lobe

28

How does Reidel clinically present?

hepatomegaly

RUQ mass

29

Where is the left lobe of the liver found?

epigastric and left hypochondriac

30

What impression is under the left lobe?

the gastric impression

31

What is the medial segment of the left lobe??

quadrate lobe

32

Where is the quadrate lobe found?

posterioinferior Lt. lobe

bounded by GB fossa, porta hepatis and umbilical vein fossa

33

What is the caudate lobe?

posterior portion of the liver

small

34

What separates the caudate lobe from the left lobe?

ligamentum venosum

35

Of Couinaud's 8 segments of the liver, what is segment two?

lateral left lobe (superior)

36

What is segment I of couinaud's surgical resection of the liver?

caudate lobe

37

Who is Couinaud?

Created the surgical resection of the liver with 8 segments

38

What are the segments based on?

what we see of the portal and hepatic veins

39

how do ligaments and fissures appear on US?

appear echogenic or hyperechoic because of the presence of collagen and fat within and around the structures

40

What are the ligament and fissures?

Glisson capsule

main lobar fissure

falciform ligament

ligamentum teres (round ligament)

ligamentum venosum

41

What is glisson's capsule

thin connective tissue

thickest around the IVC and porta hepatis

42

what is the main lobar fissure?

boundary between right and left lobes

hyper echoic line from portal vein to GB

picture slide 32

43

What is the falciform ligament?

helps attach liver to diaphragm

formed from mid-portion of coronary ligament

inferior margin contains ligamentum teres

44

What is the ligamentum teres?

echogenic focus

dividing the medial and lateral left lobe

circular echogenic structure

45

Why is the ligamentum teres special?

remnant of umbilical vein (belly button to placenta)

potential to recanalize - (when there is portal HTN it can pop open and make it a vein again. cirrhosis can cause this too)

46

What is the ligamentum venosum a remnant of?

ductus venosus

thin echogenic line anterior to the caudate lobe

47

Where is the right intersegmental fissure?

the RHV lays in this fissure

dividing anterior and posterior

48

Where is the left intersegmental fissure?

the LHV lays in this fissure

divides left lobe into medial and lateral

49

What are the coronary and triangular ligaments?

suspends the liver from the diaphragm

Has NOTHING to with the heart

50

What size does the portal vein need to be to be normal?

< 13mm in AP

51

How does the RPV course through the liver?

courses laterally and posteriorly

splits into anterior and posterior branches

52

What does an enlarged portal vein indicate?

portal hypertension

53

do the IVC and the MPV ever connect?

no

54

what are the two kinds of liver cells?

hepatocytes

kupffer cells

55

What do hepatocytes do?

synthesize

metabolize

excrete compounds

56

What do the kupffer cells do?

finish

57

What is one thing we use the liver for in US?

to evaluate other organs

58

where would we find the pancreas in relation to the liver?

seen just inferior to the left lobe

59

what area of the body does the right lobe of the liver occupy?

the right hypochondrium

60

Is Reidel's lobe more common in men or women?

women

61

What is the texture of Reidel's lobe?

normal texture

62

Reidel's lobe is an elongation of which segment?

segment VI

63

What is the caudate lobe bounded by?

porta hepatis

IVC fossa

ductus venosus fossa

64

What is segment III of Couinaud's liver resection?

lateral left lobe - inferior

65

What is segment IV of Couinaud's liver resection?

medial segment of the left quadrate

66

What is segment V of Couinaud's liver resection?

anterior inferior segment of the right lobe

67

What is segment VI of Couinaud's surgical liver resection?

posterior segment of the right lobe - inferior

68

What is segment VII of couinaud's liver resection?

posterior superior segment of the right lobe

69

What is segment VIII of Couinaud's liver resection?

superior anterior segment of the right lobe

70

What separates the caudate lobe from the left lobe?

ligamentum venosum

71

What does the hepatic artery do?

carries oxygenated blood from the aorta to the liver

72

how much oxygen does the hepatic artery supply to the liver?

20-30%

73

Is the hepatic artery high or low resistance?

Low resistance

74

how does the main portal vein enter the liver?

at the hilum

through the porta hepatis

75

Between the LT and RT portal vein, which is the larger branch?

The Right portal vein

76

Between the Rt and LT portal vein, which one is more anterior?

The LT portal vein

77

How does the LPV course through the liver?

superiorly

splits into medial and lateral branches

78

What supplies >60% of the blood supply to the liver?

the portal vein

79

Is the portal vein higher or lower in oxygen?

lower

80

What does the main portal vein branch into?

the LT and RT portal veins

81

What is it called as the PV enters the center of the liver and the lobes that are supplied?

intrasegmental

82

Of the hepatic veins, which is the largest?

RT hepatic vein

83

of the hepatic veins, which is the smallest?

Left hepatic vein

84

Where do the hepatic veins enter the IVC?

below the diaphragm

85

What do the hepatic veins do?

drain blood from the liver and return it to the heart

86

What is the job of the RHV?

drains the right lobe

divides RT lobe into anterior and posterior segments

lies in RT segmental fissure in longitudinal plane

87

What is the job of the MHV?

separates right and left lobes

lies in main lobar fissure in trv plane

88

What is the job of the LHV?

drains left lobe

divides left lobe into medial and lateral segments

lies in left segmental fissure in trv plane

89

The portal vein carries blood from the ______ to the _____

Bowel

Liver

90

The hepatic veins drain blood from the ______ into the _____.

Liver

IVC

91

What are the main aspects of the portal veins?

SV joins SMV to form PV

Larger at their orgin

branches point to the porta hepatis

echogenic wall

traverse the lobes

intrasegmental

continuous doppler

92

What are the main aspects of the hepatic veins?

flow into the IVC

course between the lobes

larger as they drain into the IVC

branches point to the diaphragm

intersegmental

multi phasic doppler

93

What is the job of the hepatobiliary system?

metabolic - chemical reactions to sustain life

excretory - elimination of waste products of metabolism

94

What makes up the hepatobiliary system?

liver

bile ducts

GB

95

Where do the bile ducts enter the duodenum?

through the ampulla of vater

96

what structures create the common bile duct?

bile canaliculi > interlobular ducts > RT and LT hepatic ducts > common hepatic duct + cystic duct = common bile duct

97

What are the liver functions?

metabolism

waste removal

digestion

storage

detoxification

synthesis and secretion of bile

98

what part of the liver are the functional units?

the lobules

99

what do the outer margin of the lobules contain?

portal triad tracts

100

What do hepatocytes do?

synthesize

metabolize

excrete compounds

101

What do Kupffer cells do?

aka: reticuloendothelial cells

phagocytize bacteria and foreign material

102

What is the job of the metabolizing physiology of the liver?

synthesizing complex substances into simple ones for energy

103

What are the metabolism enzymes that we need to know for liver lab values?

AST (aspartase aminotransferase)

ALT (alanine aminotransferase)

Alk Phos (alkaline phosphatase)

104

What in the lab values will tell you if you have a biliary obstruction?

AST and ALT mildly elevated

Alk Phos - marked elevation

Abn in metastatic

105

What will happen with the liver lab values if you have hepatocellular obstruction?

AST and ALT - striking elevation

ALT is more specific

106

What is hepatocellular disease?

liver cells (hepatocytes) are the immediate problem

usually treated medically with supportive measures and drugs

107

What is an obstructive disorder in liver disease?

bile excretion is blocked

usually treated surgically

108

If AST and ALT are elevated, what disease are you looking for?

heart and skeletal damage

109

If ALT is elevated above AST, what is the cause?

Hepatic cause

110

If Alk phos is elevated what are you looking for?

bone disease

normal pregnancy

111

What is Alpha fetoprotein?

normally produced by the liver and yolk sac of a fetus

AFP levels decrease soon after birth

AFP probably has no normal function in adults

112

How does the GB aid in digestion?

Expels waste products

Bile is continuously formed and transported by ducts

release bilirubin when RBC are broken down

113

What does the liver store?

vitamins

iron/copper

glycogen

fat

amino acids

114

What organ eliminates Urea?

the kidneys

115

How is urea measured?

in the BUN (blood urea nitrogen lab value)

116

what might you have if the BUN is low?

severe liver disease

117

What is converted to urea?

ammonium

118

What condition do you get when there is ammonium accumulation?

breath odor - fector hepaticus

119

What does the liver detox?

poisonous substances

bacteria

alcohol

120

Bilirubin is the product of ______.

hemoglobin

121

what is uptake?

when bilirubin separated from albumin

122

What is conjugation?

When bilirubin is combined with glucuronic acid...making it soluble in water

123

What is bile?

excretory product of the liver

124

What is formed continuously in the hepatocytes?

bile

125

Bile _______ and is _________ in the ducts

collects

transported

126

What makes up bile?

water

bile salts

pigments

127

What is the job of bile?

emulsification of fat

removal of wastes

128

What is a liver function test?

AST (formerly SGOT) aspartate aminotransferase

129

What is AST?

Enzyme present in tissue with high metabolism

130

When will you find elevated AST?

With any disease that injures liver cells

131

If you have significant elevations of AST, what conditions do you potentially have?

acute hepatitis

cirrhosis

132

What does elevated bilirubin give you?

jaundice

133

What is direct bilirubin?

conjugated

elevated hepatocellular disease

elevated biliary obstruction

134

What is indirect bilirubin?

unconjugated

elevated hematologic disease

135

What happens if estrogen failures to metabolize due to liver disease?

gynecomastia (breast enlargement)

testicular atrophy

136

slide 87?

make cards?

137

What is LDH?

lactic acid dehydrogenase

138

When does LDH elevate?

moderate elevation with infectious

FINISH 88

139

When Does alk phos elevate?

good indicator of intrahepatic and extrahepatic OBSTRUCTION of the liver

140

What disturbs bilirubin?

SLIDE 90

141

What is related to the elevation of DIRECT bilirubin?

obstructive jaundice

stone, mass, neoplasm

US "sees" the cause

142

What is prothrombin time (PT)?

show blood clotting

vitamin K (adds to blood clotting)

liver disease causes an increase in PT

143

What do albumin and globulin indicate in a liver function test?

metabolic disorders

FINISH SLIDE 93

144

What is hepatocellular diseases?

Directly effects the actual liver cells (hepatocytes)

145

What are obstructive diseases?

a 'something" is blocking part of the biliary tree

a mass, stone...something blocking

146

What are the indications for US of the liver?

RUQ pain

palpable mass

hepatomegaly

jaundice

hx of alcohol abuse

abnormal LFTs

?mets

pancreatitis

147

What is the prep for liver US?

NPO for 8 hours if GB is evaluated

148

What are the relative echogenicities in the abdomen (hyperechoic to hypoechoic)?

renal sinus>>pancreas>>liver>>spleen>>renal parenchyma